| NPI | 1508312695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 6091514-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 112896) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2018-04-16 |